我们在此报告一名 47 岁男性，患有进行性截瘫。影像学显示右上肺结节、双侧肾上腺大量转移、胸腰椎骨溶解和皮下结节。右侧臀部结节的活检显示为低分化转移癌，具有高程序性细胞死亡配体 1 表达和广泛的染色体重排。患者在开始派姆单抗治疗 10 天后死亡。尸检结果证实为肺多形性癌并伴有广泛转移。染色体重排的量化揭示了正常核型的跳跃突变，随后偏差程度进一步增加。

We herein report a 47-year-old man who presented with progressive paraparesis. Imaging revealed a right upper pulmonary nodule, massive bilateral adrenal metastases, thoracolumbar vertebral osteolysis, and subcutaneous nodules. A biopsy of the right buttock nodule revealed a poorly differentiated metastatic carcinoma with high programmed cell death-ligand 1 expression and extensive chromosomal rearrangements. The patient died 10 days after the initiation of pembrolizumab treatment. Autopsy findings confirmed pulmonary pleomorphic carcinoma with extensive metastases. Quantification of chromosomal rearrangements revealed a jump-up mutation from the normal karyotype, followed by a further incremental increase in the degree of deviation.